HomeMy Public PortalAbout10613 SPARKLETT ST_Sewer__ DEPARTMENT OF COUNTY ENGMEER SEWER—SEWAGE DISPOSAL 1
DMSION OF BIIILDMG AND SAFETY PERMIT APPLICATION
OOUNTF OF X+08 ANOEI.EB
WILLIAM J. FOX, COUNTY ENGINEER ADO EISS Q 6�
FOR APPLICANT TO RLL IIL ALITY
[ADDRESS 10613 Sparklett St. SS ST
CALITYTemple CityISTRICT NO SERIAL NO PERMIT NO
MEAREOSS HT Bl LSVIlte AVe• 5' A � -��EIV DBY Rawly tarIwp..lim DATE ISSUED
NER P.L. McNutt �� _/� _53
Qh
MAIL
ADDREBB272�` San Gabriel Blvd. 8EZONE OCCUPANCY QK YAP PQ
CITY San Gabriel TEL.NO. At PCONTRACTOR L.D. & M. Const. ComMOl/" C � 3�ADDRESS 21 i71ateria AVe• NO CITY Arcadia TEL NO : NK PERMIT NO
REGISTRATION NO 113613 - 0 42 D PERMIT NO
LEGAL98TE ENCROACHMENT
OEBCRIPTIOM LOT MO MIT NO
BLOCK TRACT 19189 INDUSTRIAL
WASTE APPROVAL
SIZE OF LOT NO OF BLDG& 2 CXAROES
NOW ON LOT
BOF
UIELDING8 Res. & Garage CONNECTION CHARGE FEE
NO DESCRIPTION OF WORK FEE REIMBURSEMENT FEE
HOUSE SEWER CONNECTING TO
PUBLICBEWER ® S 860 3 b0 RECEIPT NO DATE BY
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 100
COM IE ADDITI MAL BLD OR EXCEPTION R M ROED
WORK TO HOUSE SEWER 100 NO
AL ER OR REPAIR EXISTING D E BY
SEWER OR DISPOSAL SYSTEM 100
DISCONNECT
ANOORDSPOSAL SBN SEWER
STEM100 CONNECTION DATA
SEPTIC TANK.SEEPAGE PIT OR i
PITS AMD/OR GRAINFIELD 200 STATION DEPTH
CESSPOOL—DRYWELL
SPECIAL CONDITIONS ONLY 200 / M 11HOLR REFERENCEUPP
Q
TYPE OF COMMU4ftON LENGTH FROM
OWNERS PERMIT $ l 11 00 -mm V P L EL To P L 2 S
AUTHORIZATION I TOTAL FEE 1 4150
ED
CONTRACTOR TO CONNECT THDATE TED WITH E ABOVE DESCRIBED EXISTING APPROVALS INSPECTO"SIGNATURE DATE
DWELLING TO THE PUBLIC SEWER
SIGNED THIS __ DAY OF _ — — _ -19-- NEW HOUSE SEWER grk ro c
OWNER 08 CONNECT ADDITIONAL
OWNERS AGENT _ _ _ _ __ ___ _ __ _ _ _ _ BUILDING OR WORK
SEPTIC TANK,BEEP.PIT(8)
ADDRESS AND/OR DRAIMFIELD
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLI. C68SPOOL[] DRYWELL�
CATION AND STATE THAT THE ABOVE 18 CORRECT AND AGREE
TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS ALTER REPAIR SEWEROR
REGULATING PLUMBING AND SEWERS SEWAGE DISPOSAL SYSTEM
1 HEREBY CERTIFY THAT 1 AN PROPERLY REGISTERED
ANO/OR LICENSED AS REQUIRED BY LOB ANGELES COUNTY DISCONNECT PLUG AND
ANO STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWN- ABANDON HOUSE SEWER
ER OF THE ABOVE DESCRIBED RESIDENTIAL PROPERTY DACXFILL SEPTIC TANKS
BEEP PIT(S)o CEMPOOL90
SIGNATURE L
OF PERMITTEE
_ :D & M. Const. Co._
I""m 668 1/5II